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The authors present two case reports to demonstrate wide differential diagnosis of granulomatous disorders of the hepatobiliary tract. Isolated granulomatous disorders are very rare in this area. Differantial diagnosis includes infectious and systemic diseases or chemical irritation. Granulomas often immitate malignant tumors and the surgeon could be first to diagnose this disease during liver resection or cholecystectomy.granulomatous inflammation hepatic granuloma non-specific inflammation liver resection cholecystectomy.

The classification of tumours is based on the traditional classification into epithelial, mesenchymal and less common types. The most frequent epithelial tumour is hepatocellular carcinoma, which usually develops in a cirrhotically altered liver. Its differentiation from regenerative and hyperplastic liver changes by needle biopsy may prove very difficult. Malignant mesenchymal liver tumours are rare. Because of a more frequent incidence and uncertain biological behaviour epitheloid haemangioendotheliomas are more important. Newly described units include also inflammatory pseudotumours and primary MALT lymphoma of the liver.

Tumour markers are a valuable contribution to the diagnosis and monitoring of tumours processes in the liver. They are used for early diagnosis as well as for monitoring of treatment. In particular monitoring of the dynamic of changes is important. A dominating place is still held by alpha fetoprotein. The importance of CEA is in differentiation of metastatic processes. In the diagnosis of neoplastic processes in the biliary pathways antigen CA 19-9 is most important. An important finding is also than non-specific increases of tumours markers occur in some chronic processes of the liver and biliary pathways. Despite the large number of tumour markers they are useful only in conjunction with other clinical and imaging methods.

Tumours of the biliary system (NBS) account for as many as 16% of all tumours of the GIT. Early diagnosis is difficult, contemporary treatment is not satisfactory and the prognosis is poor. It seems that one of the few therapeutic perspectives is multimodal treatment. The objective of the present work is to assemble experience with multimodal treatment of NBS.From January 1987 to December 1993 347 patients with NBS were treated, using bilioduodenal endoprostheses (BDE). In 26 patients treatment was supplemented by regional chemotherapy, in 10 by intraluminal radiotherapy, using lr 192. Average periods of survival:BDE 230 days, BDE+regional chemotherapy 662 days. Endoprostheses+intraluminal radiotherapy-survival period 96-293 days. The investigation has not yet been completed, as the majority of patients still survives.Implantation of BDE combined with regional chemotherapy significantly prolongs the life of patients with NBS. It seems that similar results will be obtained also by a combination of BDE and intraluminal radiotherapy. Multimodal treatment of NBS can be nowadays considered the method of choice in the treatment of tumours in this region.

In the group of 347 patients (pts) with biliary cancer (218 females and 129 males, age range 42-88 years), the large size bilio-duodenal endoprostheses (BDE) were inserted. The success rate in BDE implantation varied from 68 to 92% according to the localisation of the common bile duct stenosis and its anatomy. The BDE introduction was followed by step-by-step normalisation in laboratory markers of biliary obstruction in 76% of pts, the full functional capacity of BDE varied from 26 to 311 days (median 168 days). In pts treated by BDE the survival median was 210 days. Early complications did not exceed 2.2%, late complications were observed in 8% out of cases. The 30-day mortality was 1.7%.

Subjective complaints of patients with tumours of the biliary tree are late, early diagnosis is difficult and frequently impossible, the therapeutic results are unsatisfactory and the prognosis is poor. Surgical intervention is in more than 90% palliative, the tumours are not radiosensitive and their sensitivity to systemically administered cytostatics is low. The perspective of some patients was improved by implantation of bilioduodenal endoprostheses. The objective of the submitted work was to assemble experience with this method in patients with tumours of the upper portions of the biliary tree.Between January 1991 and May 1993 75 patients (42 females and 33 males, aged 48-65 years) with malignancies of the upper and middle part of the biliary tree were treated. Bilioduodenal endoprostheses (BDE) were inserted endoscopically in 70 patients. In 21 of them stenting was combined with regional chemotherapy via an implantable portho catheter. For patients with BDE alone, the median survival time was 18 months, for those with BDE and chemotherapy the median survival was 23 months (p0.01). 5-fluorouracil in monocombination was as potent as in combination with carmustine and/or doxorubicin.Endoscopic implantation of a bilioduodenal endoprosthesis with subsequent regional administration of 5-fluorouracil is an important therapeutic procedure in the treatment of malignant tumours of the upper and middle biliary tree.